ArticleNeurology2016
Why are acute ischemic stroke patients not receiving IV tPA? Results from a national registry.
Open access · bronzeAbstract read
In one paragraph
Article in Neurology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 103 papers, 2 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
103citing papers in PubMed, 2 pooled it
14.3field-weighted citation impact, top 1% of its field
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
103 citing papers in PubMed, 2 syntheses or guidelines pooled it, 195 citations in OpenAlex.
- Intravenous alteplase in minor nondisabling ischemic stroke: A systematic review and meta-analysis.European stroke journal · 2024Pooled it
- Inconsistent Classification of Mild Stroke and Implications on Health Services Delivery.Archives of physical medicine and rehabilitation · 2020Pooled it
- Randomised, controlled Trial of CT perfusion and angiography compared to CT alone in thrombolysis-eligible acute ischaemic stroke patients: The penumbra and recanalisation acute computed tomography in ischaemic stroke evaluation (PRACTISE) trial.European stroke journal · 2026Trial
- Trial
- Trial
- DSA-NRP: No-Reflow Prediction From Angiographic Perfusion Dynamics in Stroke EVT.IEEE transactions on medical imaging · 2026Article
- Thromboembolic ischemic stroke induces neutrophil recruitment and matrix metalloproteinase-9 release to enhance ischemic brain injury.Research and practice in thrombosis and haemostasis · 2026Article
- Blood RNA Signatures Enable Accurate Discrimination of Stroke Subtype and Onset Time at Hospital Admission.Research square · 2026Article
- Sex differences in baseline characteristics, stroke care, and outcomes across socioeconomic settings: a multicentre study from Switzerland, Poland, and Ukraine.Journal of neurology · 2026Observational
- Sex Disparities in Prehospital and In-Hospital Delays to Intravenous Thrombolysis in Egyptian Stroke Patients.Neuroepidemiology · 2026Article
- Acute neurology simulation-based training boosts confidence and reduces anxiety in novice neurology residents and nursing staff.BMC medical education · 2025Article
- Transcriptional and neuroprotective effects of hexokinase-2 inhibitors administered after stroke.Journal of neuroinflammation · 2025Article
- Article
- Randomised, controlled Trial of CT perfusion and angiography compared to CT alone in thrombolysis-eligible acute ischaemic stroke patients: The penumbra and recanalisation acute computed tomography in ischaemic stroke evaluation (PRACTISE) trial.European stroke journal · 2025Article
- Health and economic benefits of improving pre-hospital identification of stroke in Australian women: a modelling study.The Medical journal of Australia · 2025Article
- Comparison of access to stroke diagnostics, treatment, rehabilitation, and outcome between men and women.Global epidemiology · 2025Article
- Effectiveness and Limitations of Intravenous rt-PA Therapy in Patients with Mild Cerebral Infarction.Journal of atherosclerosis and thrombosis · 2025Review
- Optical coherence tomography enables longitudinal evaluation of cell graft-directed remodeling in stroke lesions.Experimental neurology · 2025Article
- Genistein-3'-sodium sulfonate suppresses NLRP3-mediated cell pyroptosis after cerebral ischemia.Metabolic brain disease · 2025Article
- Sex-Based Analysis of Treatment, Time Metrics, and Outcomes in Acute Ischemic Stroke Patients Treated in the Netherlands.Cerebrovascular diseases (Basel, Switzerland) · 2025Article
43 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
11 authors at 6 institutions in 2 countries.
Steven R MesséFrom the Department of Neurology (S.R.M.), Hospital of the University of Pennsylvania, Philadelphia; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Department of Neurology and Stroke Center (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (D.L.B.), Boston, MA; Duke Clinical Research Center (M.V.G.-S., M.C.); Department of Medicine (E.D.P.), Duke University, Durham, NC; and Department of Neurology (L.H.S.), Massachusetts General Hospital, Boston, MA. messe@mail.med.upenn.edu.
Pooja KhatriFrom the Department of Neurology (S.R.M.), Hospital of the University of Pennsylvania, Philadelphia; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Department of Neurology and Stroke Center (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (D.L.B.), Boston, MA; Duke Clinical Research Center (M.V.G.-S., M.C.); Department of Medicine (E.D.P.), Duke University, Durham, NC; and Department of Neurology (L.H.S.), Massachusetts General Hospital, Boston, MA.
Mathew J ReevesFrom the Department of Neurology (S.R.M.), Hospital of the University of Pennsylvania, Philadelphia; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Department of Neurology and Stroke Center (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (D.L.B.), Boston, MA; Duke Clinical Research Center (M.V.G.-S., M.C.); Department of Medicine (E.D.P.), Duke University, Durham, NC; and Department of Neurology (L.H.S.), Massachusetts General Hospital, Boston, MA.
Eric E SmithFrom the Department of Neurology (S.R.M.), Hospital of the University of Pennsylvania, Philadelphia; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Department of Neurology and Stroke Center (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (D.L.B.), Boston, MA; Duke Clinical Research Center (M.V.G.-S., M.C.); Department of Medicine (E.D.P.), Duke University, Durham, NC; and Department of Neurology (L.H.S.), Massachusetts General Hospital, Boston, MA.
Jeffrey L SaverFrom the Department of Neurology (S.R.M.), Hospital of the University of Pennsylvania, Philadelphia; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Department of Neurology and Stroke Center (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (D.L.B.), Boston, MA; Duke Clinical Research Center (M.V.G.-S., M.C.); Department of Medicine (E.D.P.), Duke University, Durham, NC; and Department of Neurology (L.H.S.), Massachusetts General Hospital, Boston, MA.
Deepak L BhattFrom the Department of Neurology (S.R.M.), Hospital of the University of Pennsylvania, Philadelphia; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Department of Neurology and Stroke Center (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (D.L.B.), Boston, MA; Duke Clinical Research Center (M.V.G.-S., M.C.); Department of Medicine (E.D.P.), Duke University, Durham, NC; and Department of Neurology (L.H.S.), Massachusetts General Hospital, Boston, MA.
Maria V Grau-SepulvedaFrom the Department of Neurology (S.R.M.), Hospital of the University of Pennsylvania, Philadelphia; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Department of Neurology and Stroke Center (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (D.L.B.), Boston, MA; Duke Clinical Research Center (M.V.G.-S., M.C.); Department of Medicine (E.D.P.), Duke University, Durham, NC; and Department of Neurology (L.H.S.), Massachusetts General Hospital, Boston, MA.
Margueritte CoxFrom the Department of Neurology (S.R.M.), Hospital of the University of Pennsylvania, Philadelphia; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Department of Neurology and Stroke Center (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (D.L.B.), Boston, MA; Duke Clinical Research Center (M.V.G.-S., M.C.); Department of Medicine (E.D.P.), Duke University, Durham, NC; and Department of Neurology (L.H.S.), Massachusetts General Hospital, Boston, MA.
Eric D PetersonFrom the Department of Neurology (S.R.M.), Hospital of the University of Pennsylvania, Philadelphia; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Department of Neurology and Stroke Center (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (D.L.B.), Boston, MA; Duke Clinical Research Center (M.V.G.-S., M.C.); Department of Medicine (E.D.P.), Duke University, Durham, NC; and Department of Neurology (L.H.S.), Massachusetts General Hospital, Boston, MA.
Gregg C FonarowFrom the Department of Neurology (S.R.M.), Hospital of the University of Pennsylvania, Philadelphia; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Department of Neurology and Stroke Center (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (D.L.B.), Boston, MA; Duke Clinical Research Center (M.V.G.-S., M.C.); Department of Medicine (E.D.P.), Duke University, Durham, NC; and Department of Neurology (L.H.S.), Massachusetts General Hospital, Boston, MA.
Lee H SchwammFrom the Department of Neurology (S.R.M.), Hospital of the University of Pennsylvania, Philadelphia; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Department of Neurology and Stroke Center (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (D.L.B.), Boston, MA; Duke Clinical Research Center (M.V.G.-S., M.C.); Department of Medicine (E.D.P.), Duke University, Durham, NC; and Department of Neurology (L.H.S.), Massachusetts General Hospital, Boston, MA.
Duke University · USUniversity of Cincinnati · USBrigham and Women's Hospital · USHarvard University · USMichigan State University · USUniversity of Calgary · CA
Funding
Small vessel disease and beta-amyloid deposition in mildly impaired cognitionR01NS062028 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI BLACKER, DEBORAH L., SMITH, ERIC E · 2008 to 2012
$2.1MNINDS NIH HHS R01 NS062028
Abstract
objectiveTo determine patient and hospital characteristics associated with not providing IV tissue plasminogen activator (tPA) to eligible patients with acute ischemic stroke (AIS) in clinical practice.
methodsWe performed a retrospective cohort study of patients with AIS arriving within 2 hours of onset to hospitals participating in Get With The Guidelines-Stroke without documented contraindications to IV tPA from April 2003 through December 2011, comparing those who received tPA to those who did not. Multivariable generalized estimating equation logistic regression modeling identified factors associated with not receiving tPA.
resultsOf 61,698 eligible patients with AIS presenting within 2 hours of onset (median age 73 years, 51% female, 74% non-Hispanic white, median NIH Stroke Scale score 11, interquartile range 6-18), 15,282 (25%) were not treated with tPA within 3 hours. Failure to give tPA decreased over time from 55% in 2003 to 2005 to 18% in 2010 to 2011 (p < 0.0001). After adjustment for all covariates, including stroke severity, factors associated with failure to treat included older age, female sex, nonwhite race, diabetes mellitus, prior stroke, atrial fibrillation, prosthetic heart valve, NIH Stroke Scale score <5, arrival off-hours and not via emergency medical services, longer onset-to-arrival and door-to-CT times, earlier calendar year, and arrival at rural, nonteaching, non-stroke center hospitals located in the South or Midwest.
conclusionsOverall, about one-quarter of eligible patients with AIS presenting within 2 hours of stroke onset failed to receive tPA treatment. Thrombolysis has improved dramatically over time and is strongly associated with stroke center certification. Additionally, some groups, including older patients, milder strokes, women, and minorities, may be undertreated.
Indexed as
Administration, IntravenousAgedAged, 80 and overBrain IschemiaDatasets as TopicFemaleFibrinolytic AgentsHealthcare DisparitiesHumansLogistic ModelsMaleMultivariate AnalysisRegistriesRetrospective StudiesSeverity of Illness IndexStrokeFibrinolytic AgentsTissue Plasminogen Activator
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.